Biomedical subjects

L Purdy

Publications and source records attributed to L Purdy.

9 recordsLinked to original sources

PubMed2006

Women's reproductive autonomy: medicalisation and beyond.

Reproductive autonomy is central to women's welfare both because childbearing takes place in women's bodies and because they are generally expected to take primary responsibility for child rearing. In 2005, the factors that influence their autonomy most strongly are poverty and belief systems that devalue such autonomy. Unfortunately, such autonomy is a low priority for most societies, or is anathema to their belief systems altogether. This situation is doubly sad because women's reproductive autonomy is intrinsically valuable for women and also instrumentally valuable for the welfare of humankind. This paper takes for granted the moral and practical necessity of such autonomy and digs deeper into the question of what such a commitment might entail, focusing on the mid-level policy making that, at least in the US and Canada, plays a significant role in shaping women's options. This paper examines a large teaching hospital's policy on reduction of multifetal pregnancies. The policy permits reduction of triplets to twins, but not twins to a singleton. As there is no morally relevant difference between these two types of reduction, it is evident that inappropriate medicalisation can still limit women's autonomy in undesirable ways.

Abortion, Therapeutic↗

PubMed2001

Waiting lists for radiation therapy: a case study.

BACKGROUND: Why waiting lists arise and how to address them remains unclear, and an improved understanding of these waiting list "dynamics" could lead to better management. The purpose of this study is to understand how the current shortage in radiation therapy in Ontario developed; the implications of prolonged waits; who is held accountable for managing such delays; and short, intermediate, and long-term solutions. METHODS: A case study of the radiation therapy shortage in 1998-99 at Princess Margaret Hospital, Toronto, Ontario, Canada. Relevant documents were collected; semi-structured, face-to-face interviews with ten administrators, health care workers, and patients were conducted, audio-taped and transcribed; and relevant meetings were observed. RESULTS: The radiation therapy shortage arose from a complex interplay of factors including: rising cancer incidence rates; broadening indications for radiation therapy; human resources management issues; government funding decisions; and responsiveness to previous planning recommendations. Implications of delays include poorer cancer control rates; patient suffering; and strained doctor-patient relationships. An incompatible relationship exists between moral responsibility, borne by government, and legal liability, borne by physicians. Short-term solutions include re-referral to centers with available resources; long-term solutions include training and recruiting health care workers, improving workload standards, increasing compensation, and making changes to the funding formula. CONCLUSION: Human resource planning plays a critical role in the causes and solutions of waiting lists. Waiting lists have harsh implications for patients. Accountability relationships require realignment.

Cancer Care Facilities↗

PubMed2001

Xenografts: are the risks so great that we should not proceed?

Animal organs could save patients needing transplants, but further research is necessary to resolve remaining problems with organ rejection. Furthermore, xenotransplantation risks transmitting animal pathogens to patients and to the general population. It would be unethical to proceed with clinical trials before principles and procedures for dealing with this risk are in place.

Animals↗

PubMed2001

Medicalization, medical necessity, and feminist medicine.

New and proposed medical technologies continually challenge our vision of what constitutes appropriate medical treatment. As scholars and consumers grapple with the meaning of innovation, one common critical theme to surface is that it constitutes undesirable medicalization. But we are embodied creatures who can often benefit from medical knowledge; in addition, rejection of medicalization may be in some cases based on an untenable appeal to nature. Harnessing the power of medicine for women's welfare requires us to rethink the goals of medicine as well as implement fundamental reforms.

Abortion, Induced↗

PubMed2000

Priority setting for new technologies in medicine: qualitative case study.

OBJECTIVE: To describe priority setting for new technologies in medicine. DESIGN: Qualitative study using case studies and grounded theory. SETTING: Two committees advising on priorities for new technologies in cancer and cardiac care in Ontario, Canada. PARTICIPANTS: The two committees and their 26 members. MAIN OUTCOME MEASURES: Accounts of priority setting decision making gathered by reviewing documents, interviewing members, and observing meetings. RESULTS: Six interrelated domains were identified for priority setting for new technologies in medicine: the institutions in which the decision are made, the people who make the decisions, the factors they consider, the reasons for the decisions, the process of decision making, and the appeals mechanism for challenging the decisions. CONCLUSION: These domains constitute a model of priority setting for new technologies in medicine. The next step will be to harmonise this description of how priority setting decisions are made with ethical accounts of how they should be made.

Costs and Cost Analysis↗

PubMed2000

Should we add "xeno" to "transplantation"?

Proponents of xenotransplantation hope that it will provide organs to fill the gap between the demand for and supply of organs for transplant. The scientific obstacles to transplanting animal organs into humans are daunting, as are the moral, political, and policy issues. Among them are concerns about animal rights and welfare, patient acceptance and informed consent, and broader public health issues, such as the cost-efficient deployment of scarce resources and the risk of disease in third parties. The latter is, in my view, the most immediately urgent issue. Pigs, the current animal of choice, carry many bacterial and viral pathogens, and it is currently impossible to assess the risk of disease to human populations. Because of this risk, a moratorium on xenotransplantation is necessary to protect public health; it is also questionable whether the technology, if successful, would be the most cost-effective way to promote health.

Animal Experimentation↗

PubMed1994

Combined use of behavior modification and very low-calorie diet in weight loss and weight maintenance.

The authors assessed the long-term efficacy of a weight-loss program combining the use of a very low-calorie diet and behavior modification. This program involved medical supervision as well as group behavior modification classes, which emphasized long-term lifestyle changes, along with nutrition education. A study was conducted in 1984 and again in 1991, of unselected consecutive patients who had completed this hospital-based, weight-control program 12 to 18 months earlier. Patients were asked to return to the medical center to be weighed and complete a questionnaire regarding biobehavioral factors. The results of both the 1984 and 1991 follow-up studies were very similar. The patients' initial body mass index was 34.6 kg/m2 +/- 0.57 kg/m2 (mean +/- standard error of the mean, n = 109) and average weight loss was 23.2 kg +/- 1.1 kg, resulting in a body mass index of 26.2 kg/m2 +/- 0.42 kg/m2 upon completion of the program. At 12 to 18 months of follow-up, mean body mass index was 29.6 kg/m2 +/- 0.54 kg/m2. There was a wide spectrum of long-term compliance and recidivism. On average, 61% of patients kept off at least 50% of the weight they had originally lost. In addition, medication usage for hypertension, hyperlipidemia, and diabetes was reduced among the patients with reduced obesity. A retrospective analysis of patient characteristics and habits did not accurately predict which patients would be successful long-term.(ABSTRACT TRUNCATED AT 250 WORDS)

Behavior Therapy↗

PubMedDate not supplied

Attributions of cause and recurrence in long-term breast cancer survivors.

UNLABELLED: Women are bombarded with information about the purported causes and the prevention of breast cancer. This survey sought to determine to what women survivors of breast cancer attributed the cause and lack of recurrence of their breast cancer, and whether these views were associated with specific health behaviors. METHODS: Women who had survived breast cancer without recurrence for at least 2 years were surveyed by mail about their views on the cause and lack of recurrence of their breast cancer. They were also asked to estimate their personal risk of cancer recurrence, report on their health behaviors, describe what advice they would give to women newly diagnosed with breast cancer, and what they would change if they had to relive their breast cancer experience. RESULTS: 378 (75.6%) women breast cancer survivors responded who had been recurrence free for a mean of 8.6+/-11.8 years. Women (n=322) who responded to the question about the cause of breast cancer attributed it to stress (42.2%), genetics (26.7%), environment (25.5%), hormones (23.9%), don't know (16.5%), diet (15.5%), and breast trauma (2.8%). Women (n=330) who responded to the question about what prevented cancer recurrence attributed it to positive attitude (60.0%), diet (50.0%), healthy lifestyle (40.3%), exercise (39.4%), stress reduction (27.9%), prayer (26.4%), complementary therapies (11.2%), don't know (5.1 %), luck (3.9%), and tamoxifen (3.9%). Most women felt their recurrence risk was average (44.8%), or below average (35.8%). Some attributions of breast cancer cause or lack of recurrence were associated with specific health behaviors. The majority of women survivors would advise other women with breast cancer to be positive, and if they had to relive their cancer experience they would take more control of their treatment. DISCUSSION: Despite lack of evidence substantiating stress as a cause of breast cancer, many breast cancer survivors believed stress caused their cancer. An even higher percentage of survivors believed their positive attitude had prevented breast cancer recurrence and they would advise other women with breast cancer accordingly. Attribution beliefs clearly affected survivors' health behaviors. CONCLUSION: Healthcare providers should consider the personal beliefs of patients about cancer cause and recurrence, which may be at variance with scientific evidence. This may assist in framing the management of patients in personally meaningful ways, which may increase health behaviors, adherence, satisfaction and quality of life. Whether it will increase survival remains unknown.

Adaptation, Psychological↗

PubMedDate not supplied

Long-term breast cancer survivors: confidentiality, disclosure, effects on work and insurance.

UNLABELLED: As more women are diagnosed with breast cancer, more will survive the illness from a few years to a lifetime. This study sought to determine the experience of Canadian breast cancer survivors with respect to the impact of cancer on confidentiality, work and insurance. METHOD: Women who had survived breast cancer without recurrence for at least 2 years completed a mail survey about the effect of their illness on confidentiality, disclosure, work and insurance. RESULTS: 378 (75.6%) women breast cancer survivors responded to the survey. Their mean age was 61.0+/-10.9 years, and 67.6% had been recurrence free for more than 5 years. The majority of women rated hospital staff, family doctors, family, friends, and support groups at the highest possible level of confidentiality. Over 70% of survivors disclosed their diagnosis to friends, children, siblings, and partners, while over 50% disclosed to work colleagues and supervisors. However, over 40% felt cancer had altered their priorities or progress at work, and 5% were afraid to change jobs in case they became ill again. There was a lack of knowledge about insurance but, of the types of insurance identified, life insurance (17.9%), extended health insurance (7.7%), and private disability insurance (4.4%) were reported to have been refused or offered only with higher premiums as a result of a past diagnosis of breast cancer. DISCUSSION: A substantial minority of women perceived that cancer had substantially affected their personal and work lives. Although most felt their illness confidentiality was well protected and they disclosed freely to family, friends, and work, over 40% of women survivors reported that cancer had affected their work in various ways, and nearly 20% identified insurance problems. It appears that disclosure sometimes results in negative work and insurance experiences. CONCLUSIONS: Health professionals and cancer survivors should engage in education about the potential positive and negative effects of disclosure, and advocacy against cancer-based work and insurance discrimination.

Adaptation, Psychological↗